This document summarizes trends in childhood obesity in the United States. It finds that obesity rates have doubled in children ages 2-5 and tripled in children ages 6-11 and 12-19 between 1976-2008. Currently, around 32% of children and adolescents are overweight or obese. Obesity rates vary significantly by race and ethnicity, with non-Hispanic black and Hispanic youth having higher rates. Childhood obesity is associated with serious health risks that often continue into adulthood such as cardiovascular disease, diabetes, and psychological issues. A multifaceted response is needed that addresses individual, family, community and societal factors contributing to the current obesogenic environment experienced by many youth.
Putting the Health in Healthcare: Partnerships with Hospitals
Hospitals and active transportation advocates are working together to make their communities healthier. Hear from health professionals in Ohio, Pennsylvania and Washington, DC who are linking the healthy lifestyle expertise of hospitals with active transportation facilities.
Presenters:
Presenter: David Pauer Cleveland Clinic
Co-Presenter: Bonnie Coyle St. Luke's University Health Network
Co-Presenter: Elissa Garofalo Delaware & Lehigh National Heritage Corridor
Co-Presenter: Elissa Southward Rails-to-Trails Conservancy
Overweight and Medical Condition in US : 3 Factors that affect Childhood obe...Sumit Roy
Obesity and the risk of being overweight, leads to not only chronic medical condition, but also makes an individual susceptible to many kinds of conditions. The paper from American heart foundation. shares numbers that are quite frightning
Putting the Health in Healthcare: Partnerships with Hospitals
Hospitals and active transportation advocates are working together to make their communities healthier. Hear from health professionals in Ohio, Pennsylvania and Washington, DC who are linking the healthy lifestyle expertise of hospitals with active transportation facilities.
Presenters:
Presenter: David Pauer Cleveland Clinic
Co-Presenter: Bonnie Coyle St. Luke's University Health Network
Co-Presenter: Elissa Garofalo Delaware & Lehigh National Heritage Corridor
Co-Presenter: Elissa Southward Rails-to-Trails Conservancy
Overweight and Medical Condition in US : 3 Factors that affect Childhood obe...Sumit Roy
Obesity and the risk of being overweight, leads to not only chronic medical condition, but also makes an individual susceptible to many kinds of conditions. The paper from American heart foundation. shares numbers that are quite frightning
During the past 20 years there has been a dramatic increase in obesity in the United States. This slide set illustrates this trend by mapping the increased prevalence of obesity across each of the states.
Explains what troubleshooting is, what skills are involved, and clears up some common misconceptions. Originally designed with IT Helpdesks in mind, but it could apply to any kind of troubleshooting.
=========================
Wrote this a VERY long time ago! I always meant to revisit/revamp it, but never quite got round to it. But people seem to get value from it, so I'll leave it up :)
SlideShare now has a player specifically designed for infographics. Upload your infographics now and see them take off! Need advice on creating infographics? This presentation includes tips for producing stand-out infographics. Read more about the new SlideShare infographics player here: http://wp.me/p24NNG-2ay
This infographic was designed by Column Five: http://columnfivemedia.com/
During the past 20 years there has been a dramatic increase in obesity in the United States. This slide set illustrates this trend by mapping the increased prevalence of obesity across each of the states.
Explains what troubleshooting is, what skills are involved, and clears up some common misconceptions. Originally designed with IT Helpdesks in mind, but it could apply to any kind of troubleshooting.
=========================
Wrote this a VERY long time ago! I always meant to revisit/revamp it, but never quite got round to it. But people seem to get value from it, so I'll leave it up :)
SlideShare now has a player specifically designed for infographics. Upload your infographics now and see them take off! Need advice on creating infographics? This presentation includes tips for producing stand-out infographics. Read more about the new SlideShare infographics player here: http://wp.me/p24NNG-2ay
This infographic was designed by Column Five: http://columnfivemedia.com/
No need to wonder how the best on SlideShare do it. The Masters of SlideShare provides storytelling, design, customization and promotion tips from 13 experts of the form. Learn what it takes to master this type of content marketing yourself.
10 Ways to Win at SlideShare SEO & Presentation OptimizationOneupweb
Thank you, SlideShare, for teaching us that PowerPoint presentations don't have to be a total bore. But in order to tap SlideShare's 60 million global users, you must optimize. Here are 10 quick tips to make your next presentation highly engaging, shareable and well worth the effort.
For more content marketing tips: http://www.oneupweb.com/blog/
Are you new to SlideShare? Are you looking to fine tune your channel plan? Are you using SlideShare but are looking for ways to enhance what you're doing? How can you use SlideShare for content marketing tactics such as lead generation, calls-to-action to other pieces of your content, or thought leadership? Read more from the CMI team in their latest SlideShare presentation on SlideShare.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
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Turbocharge your online presence with SlideShare. We provide the best tips and tricks for succeeding on SlideShare. Get ideas for what to upload, tips for designing your deck and more.
Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done.
http://dosomething.org.nz
In recognition of National Childhood Obesity Awareness Month, I developed and facilitated a community-based "Lunch and Learn" session. I provide background information, statistics and informational resources pertaining to the obesity epidemic. Additionally, I provided nutrition and fitness related strategies to foster a healthy lifestyle.
The Surgeon General’s Vision for a Healthy and Fit Nation.docxssusera34210
The Surgeon General’s Vision
for a Healthy and Fit Nation
2010
U.S. Department of Health and Human Services
The Surgeon General’s Vision
for a Healthy and Fit Nation
2010
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Office of the Surgeon General
Rockville, MD
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Office of the Surgeon General
This publication is available on the World Wide Web at
http://www.surgeongeneral.gov
Suggested Citation
U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and
Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon
General, January 2010.
INTRODUCTION ◊ 1
MESSAGE FROM THE SURGEON
GENERAL
Our nation stands at a crossroads. Today’s
epidemic of overweight and obesity threatens the
historic progress we have made in increasing
American’s quality and years of healthy life.
Two-third of adults1 and nearly one in three
children are overweight or obese.2 In addition,
many racial and ethnic groups and geographic
regions of the United States are
disproportionately affected.3 The sobering impact
of these numbers is reflected in the nation’s
concurrent epidemics of diabetes, heart disease,
and other chronic diseases. If we do not reverse
these trends, researchers warn that many of our
children—our most precious resource—will be
seriously afflicted in early adulthood with
medical conditions such as diabetes and heart
disease. This future is unacceptable. I ask you to
join me in combating this crisis.
Every one of us has an important role to play in
the prevention and control of obesity. Mothers,
fathers, teachers, business executives, child care
professionals, clinicians, politicians, and
government and community leaders—we must
all commit to changes that promote the health
and wellness of our families and communities.
As a nation, we must create neighborhood
communities that are focused on healthy nutrition
and regular physical activity, where the healthiest
choices are accessible for all citizens. Children
should be having fun and playing in
environments that provide parks, recreational
facilities, community centers, and walking and
bike paths. Healthy foods should be affordable
and accessible. Increased consumer knowledge
and awareness about healthy nutrition and
physical activity will foster a growing demand
for healthy food products and exercise options,
dramatically influencing marketing trends.
Hospitals, work sites, and communities should
make it easy for mothers to initiate and sustain
breastfeeding as this practice has been shown to
prevent childhood obesity. Working together, we
will create an environment that promotes and
facilitates healthy choices for all Americans. And
we will live longer and healthier lives.
In the 2001 Surgeon General’s Call to Action to
Prevent and Decrease Overwei ...
1Running head OBESITY IN MIDWESTERN CHILDREN.docxherminaprocter
1
Running head: OBESITY IN MIDWESTERN CHILDREN
Obesity in Midwestern Adolescents
NR222: Health and Wellness
January 2019
Obesity in Midwestern Adolescents
It is no secret that obesity in America is at an alarming level and although we see its prevalence in adults, we often fail to discuss its rising rates within adolescents. Children are now facing the possibility of higher mortality rates, when in reality, children should be living longer than their parents. With obesity striking Midwestern communities, this paper aims to focus on understanding why children in these communities are at a higher risk and what actions are needed to help them overcome this harmful life style. This is incredibly important in order to restore and maintain health. Children who are obese have a higher comorbidity for chronic diseases that typically only affect adults such as, type II diabetes mellitus, hypertension, hyperlipidemia as well as psychological disorders. This stresses the importance that adolescents should be happy and healthy, not a statistic.
Target Population: Midwestern Adolescents
To be considered as this paper’s target population an individual must meet two criteria: the person must reside in the American Midwest and be an adolescent. The State of Obesity (2016-17) ranks all fifty states against one another in obesity. Although the rankings are not confined to adolescents, it highlights where midwestern states stand in relation to the rest of the United States. The lower the number next to the state, higher portion of the population is obese : 6. Ohio (18.6%), 10. Iowa (17.7%), 11. Indiana (17.5%), 12. Michigan (17.3%), 17. Illinois (16.2%), 23. Nebraska (15.5%), 31. Wisconsin (14.3%), 34. South Dakota (13.6%), 38. Kansas (13.0%), 40. Missouri (12.7%), 42. North Dakota (12.5%) and 48. Minnesota (10.4%).These statistics provide an overview of midwestern obesity, let us now turn to risk factors contributing to adolescent specific obesity. The goal of Healthy People 2020 is to increase life expectancy and quality of life. According to their website, 1 in 6 children and adolescents are obese. That number is concerning because many adolescents do not understand the consequences of their actions and how it can be detrimental later on in their adult years. Healthy People 2020 initiatives are aimed in helping adolescents in 1. achieving and maintaining a healthy weight, 2. Reduce the risk of heart disease and stroke, 3. Reduce the risk of certain forms of cancer, 4. Strengthen muscles, bones and joints and 5. Improve mood and energy level (Healthy People 2020, n.d.).According to Stanford Children’s Health (n.d.),one of the biggest contributors to adolescent obesity is excessive food intake which results in a surplus of caloric intake. A diet that is high in sugar and fat, as well as processed, will result in weight gain. As busy parents tend to their kids and their extracurriculars, eating on the go often results in poor food and bev.
Twenty percent of American teenager are overweight. This may be the first generation where the parents will out-live their children. Snacks are heavy with calories, but are convenient and everyday life is fast-paced. Developing a healthy snack that is affordable may the best way to go.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
Running head PICOT STATEMENT 1PICOT STATEMENT 5.docxtoltonkendal
Running head: PICOT STATEMENT 1
PICOT STATEMENT 5
PICOT Statement: Childhood Obesity
P-I-C-O-T Statement
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to nutritional education, endoscopic bariatric surgical intervention
O- Improved health outcomes in terms of overall weight
T - A year’s time limit
PICOT Statement: Childhood Obesity
Introduction
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
PICOT Statement
Population
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Intervention
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative ...
Similar to Orthopaedic Issues with Childhood Obesity (20)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. HSS educational activities are carried out in a manner that serves the educational component of our Mission. As faculty we are committed to providing transparency in any/all external relationships prior to giving an academic presentation. Maura D. Frank, M.D. Weill Cornell Medical College Komansky Center for Children’s Health Disclosure: I DO NOThave a financial relationship with any commercial interest. :
3. Obesity: The Problem Overweight and obesity are a major public health concern in the United States. 33.8% prevalence of obesity in adults in 2007-2008.1,2
8. Classification in Children and Adolescents Overweight: 85th to 94th %ile of the gender-specific body mass index (BMI) growth charts for age and gender. Obesity: at or above the 95th percentile for age and gender. Obesity among adults is defined as a BMI of 30 or higher. 5 Extreme Obesity: at or above the 99th %ile BMI for age and gender
9.
10. National data: Obesity and Overweight 2003-2006: 16.3% obese 15.6% overweight 31.9% overweight or obese 11.3% at or above the 97th %ile 2007-2008 16.9% obese 14.8% overweight 31.7% overweight or obese 11.9% at or above the 97th %ile3,4
11. New York City New York City 2009: 21% of public school children from kindergarten to eighth grade are obese, and another 18% overweight 6 NYPH/Komansky Center 2005: 27% of adolescent patients in the general clinical practice were obese and another 19.5% overweight.
14. Racial/Ethnic disparities: Females 1988-1994: Female non-Hispanic black adolescent at 16.3% were more likely to be obese compared with non-Hispanic white adolescent girls at 8.9%. 2007-2008: Female non-Hispanic black adolescents were significantly more likely to be obese at 29.2% compared with non-Hispanic white adolescents at 14.5%. Between 1988-1994 and 2007-2008 the prevalence of obesity increased: From 8.9% to 14.5% among non-Hispanic white girls. From 16.3% to 29.2% among non-Hispanic black girls. From 13.4% to 17.4% among Mexican-American girls. 7
16. Infants and Toddlers 2008 obesity prevalence in low income preschoolers in Head Start Overall rate 14.6% (10.4% all pre-schoolers) American Indian or Alaskan native: 21.2%8 Only 2 states, Colorado and Hawaii, had obesity prevalences ≤ 10% for this population. 7 Elevated rates of weight for length in 0-2 year olds: 9.5% overall, but 14.9% for Hispanic males 3
17. Table 1. Prevalence of High Weight for Recumbent Length Among US Children From Birth to 2 Years of Age, 2007-2008a,b. Ogden, C. L. et al. JAMA 2010;303:242-249 Copyright restrictions may apply.
18. Co-morbidities of childhood obesity Significant co-morbidities in youth Tracking of obeisty and co-morbidities to adulthood Strong evidence that obese children and youth are likely to become obese adults.9-12 The Bogalusa Heart Study: 25% of obese adults were overweight as children, and that if onset of overweight is prior to 8yo, obesity in adulthood is likely to be moresevere.13
19. Co-Morbidities Cardiovascular Elevated blood pressure, at least 13% having increased systolic BP and 9% with elevated diastolic BP.14 Elevated LDL cholesterol, low HDL13 Effects of deconditioning
20. Co-Morbidities Endocrine/Metabolic Type II Diabetes15: Close to half of newly diagnosed cases of diabetes in children are Type II 16 Polycystic Ovarian Syndrome: women with POS are more likely to be obese17 Vitamin D Deficiency
21. Respiratory/ENT Asthma may occur more frequently and be exacerbated by obesity18 Obstructive Sleep Apnea: daytime sleepiness, poor attention, academic difficulties, RVH/pulmonary hypertension19-21 Worsening of asthma due to inactivity?
22. Co-morbidities Neurologic Pseudotumorcerebri22 Rare but can result in vision loss Obesity is one of several risk factors Psychiatric Quality of life23 Depression Sexual and physical abuse may increase risk
23. Co-morbidities GI NAFLD (steatosis, steatohepatitis, fibrosis, cirrhosis) 24-25 Cholelithiasis26 GERD and constipation exacerbated27,28 Musculoskeletal Blount Disease SCFE Osgood Schlatter’s Increased fractures and musculoskeletal discomfort Joint changes/osteoarthritis 29-32
24. Genetic Influences Family History: parental obesity and family history of Type2 DM 33,16 Twin studies34 Hormones that influence appetite, satiety, and fat distribution: leptin, ghrelin, adiponectin35 Genetic conditions causing obesity are rare: Primary Cushing syndrome (short, violaceousstriae) and Prader-Willi
25. Prenatal and early childhood effects Infants of Diabetic mothers: cycle of increased risk of obesity, later diabetes 36 Excessive maternal weight gain: Children of women whose weight gain during gestation exceeded IOM guidelines were 48% more likely to be overweight at age 7 than children whose weight gain was in the recommended range.37
26. Prenatal and early childhood effects: Nicotine exposure Strong relationship between maternal smoking and subsequent obesity, hypertension, and type 2 diabetes in offspring. May be mediated via nicotine’s direct effects on the hypothalamus, altering its regulation of body weight and energy balance May also be related to low birth weight, a well established outcome of maternal cigarette smoking, and a significant risk factor for the development of obesity, hypertension, and type 2 diabetes.38
27. Prenatal and early Childhood Effects Breastfeeding: Breastfeeding decreases the risk of obesity The longer the duration of breastfeeding, the better the protective effect. 39,40 Timing of introduction of solid foods: Introduction of solid foods in formula fed infants prior to 4 months is associated with a 6-fold increase in risk of obesity at age 3 years. 41 Sleep: Evidence accumulating for short sleep duration as a risk factor for childhood obesity42,43
28. How did we get here?The “Obesigenic” Environment Sugar Sweetened Beverages (SSBs) School breakfast and lunch: school lunch associated with rapid weight gain in low-income girls 44 Food availability and choice in low income neighborhoods45-47 Portion size
29. The “Obesigenic” Environment PA in schools Decline Emphasis on academics Outside play Associated with lower BMI Safety concerns Play and activity venues Screen time48
30. Tackling the Problem AAP/AMA Task Force 2007: promotion of a step-wise approach toward obesity, from prevention to intensive, multidisciplinary interventions 49 Intensive intervention programs combining both nutrition and physical activity show varying rates of success 50
31. NYPH-Komansky Health For Life Program (H4L) Multidisciplinary healthy lifestyle program for 8-18 year olds who are either overweight or obese (≥ 85th %ile BMI). Multidisciplinary team of physicians (general pediatrician and adolescent specialist, pediatric residents), dietitians, physical therapists, a social worker, a nurse, and medical student mentors Three month intensive program with one year follow-up includes individual visits and a 10-week core workshop and activity series
32. Health for Life Baseline Measurements BMI %ile Mean 97.2th %ile (Y), 97.5th %ile (O) Range 85th – 100th %ile Blood pressure: 36% systolic BP ≥ 120 7% systolic BP ≥ 130 HDL: 40% abnormal (<40 mg/dL) Vitamin D: 58.8% deficient (<20ng/mL) 38.2% insufficient (20-29 ng/mL)
33. Results: BMI z-scores (Groups 1-10) Younger cohort (8-11 yo) 66% of participants decreased BMI z-score Mean decreased from 2.12 to 2.05 Older cohort (12-18 yo) 48% of participants decreased BMI z-score Mean decreased from 2.26 to 2.16
38. References 11. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 37(13):869–873. SerdulaMK, Ivery D, Coates RJ, Freedman DS. Williamson DF. Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167–177. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood overweight to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study. Pediatrics 2001;108:712–718. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. JPediatr. 2007 Jan;150(1):12–17.e2. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Reiger V, Taksali S, Barbetta G, Sherwin RS, Caprio, S. Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity. The New England Journal of Medicine. 2002; 346(11): 802-810. Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136:664 – 672. MichelmoreKF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. ClinEndocrinol (Oxf). 1999;51:779 –786. Ford ES. The epidemiology of obesity and asthma. J Allergy ClinImmunol. 2005;115:897–909. Wing YK, Hui SH, Pak WM, et al. A controlled study of sleep related disordered breathing in obese children. Arch Dis Child. 2003;88:1043–1047.
39. References Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children: associations with obesity, race, and respiratory problems. Am J RespirCrit Care Med. 1999;159:1527–1532. Kalra M, Inge T, Garcia V, et al. Obstructive sleep apnea in extremely overweight adolescents undergoing bariatric surgery. Obes Res. 2005;13:1175–1179. Scott IU, Siatkowski RM, Eneyni M, Brodsky MC, Lam BL. Idiopathic intracranial hypertension in children and adolescents. Am J Ophthalmol. 1997;124:253–255. SchwimmerJB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813–1819 Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The Epidemiology of Obesity. Gastroenterology. 2007;132: 2087-2102. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C. Prevalence of Fatty Liver in Children andAdolescents. Pediatrics. 2006; 118; 1388-1393 Kaechele V, Wabitsch M, Thiere D, et al. Prevalence of gall- bladder stone disease in obese children and adolescents: influenceof the degree of obesity, sex, and pubertal development. J PediatrGastroenterolNutr. 2006;42:66 –70. Fishman L, Lenders C, Fortunato C, Noonan C, Nurko S. Increased prevalence of constipation and fecal soiling in a population of obese children. J Pediatr. 2004;145:253–254.
40. References HampelH, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophagealreflux disease and its complications. Ann Intern Med. 2005;143:199 –211 Wearing SC, Hennig EM, Byrne NM, Steele JR, Hills AP. Musculoskeletal Disorders Associated with Obesity: a Biomechanical Perspective. Obesity Reviews.2006; 7(3): 239-250 Dietz WH Jr, Gross WL, Kirkpatrick JA Jr. Blount disease (tibia vara): another skeletal disorder associated with childhood obe- sity. J Pediatr. 1982;101:735–737 ManoffEM, Banffy MB, Winell JJ. Relationship between body mass index and slipped capital femoral epiphysis. J PediatrOrthop. 2005;25:744 –746 Taylor ED, Theim KR, Mirch MC, et al. Orthopedic complica- tions of overweight in children and adolescents. Pediatrics. 2006;117:2167–2174 Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869 – 873 Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet. 1997;27:325–351 Gale SM, Castracane VD, Mantzoros CS. Energy homeostasis, obesity and eating disorders: recent advances in endocrinology. J Nutr. 2004;134:295–298systems for prevention in primary care: randomised trial. BMJ. 2004;328:388 Dabelea, D. The Predisposition to Obesity and Diabetes in Offspring of Diabetic Mothers. Diabetes Care. 2007; 30:Supplement 2.
41. References WrotniakBH, Shults J, Butts S, Stettler N, Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study, American Journal of Clinical Nutrition, 2008, 87(6): 1818-24 Bruin JE, Gerstein HC, Holloway AC. Long-Term Consequences of Fetal and Neonatal Nicotine Exposure: A Critical Review. Toxicological Sciences 2010; 116(2):364-374 Division of Nutrition and Physical Activity: Research to Practice Series No. 4: Does breastfeeding reduce the risk of pediatric overweight? Atlanta: Centers for Disease Control and Prevention, 2007. http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/breastfeeding_r2p.pdf Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367-1377. Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of Solid Food Introduction and Risk of Obesity in PreSchool Aged Children. Pediatrics doi:10.1542/peds.2010-0740. Chen X, Beydoun MA, Wang Y. Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring). 2008:16(2):265-274. 43. TaverasEM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW. Short Sleep Duration in Infancy and Risk of Childhood Overweight. Arch PediatrAdolesc Med. 2008 April; 162(4): 305-311. 44. HernancezDC, Francis La, Doyle EA. National School Lunch Participation and Sex Differences in Body Mass Index Trajectories of Children From Low-Income Families. Arch PediatrAdolesc Med. doi: 10.1001/archpediatricd.2010.253
42. References 45. MorlandK,Wing S, Diez Roux A, Poole C. Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places. American Journal of Preventive Medicine. 2002; 22(1): 23-29 46. MorlandK, Filomena S. Disparities in the Availability of Fruits and Vegetables between Racially Segregated Urban Neighborhoods. Public Health Nutrition. 2007; 10: 1481-9 47. Powell LP, Auld C, Chaloupka FJ, O’Malley PM, Johnson LD. Associations Between Access to Food Stores and Adolescent Body Mass Index. Am J Prev Med 2007;33(4S):S301-S307. 48. Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income pre-school children. Pediatrics 2002 June: 109(6); 1028-35. 49. Barlow SE, and the Expert Committee. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics. 2007; 120: S 164-192 50. Savoye M, Shaw M, Dziura J, Tamborlane MD, Rose P, Guandalini C, Goldberg-Cell R, Burgert T, Cali A, Weiss R, Caprio S. Effects of a Weight Management Program on Body Composition and Metabolic Parameters in Overweight Children. JAMA 2007;297:2697-2704.
43. 40 Orthopaedic Issues in theYoung Obese Athlete Daniel W. Green, MS, MD, FACS, FAAP Pediatric Orthopaedic Surgery Hospital for Special Surgery Associate Clinical Professor Cornell University Medical College
44. HSS educational activities are carried out in a manner that serves the educational component of our Mission. As faculty we are committed to providing transparency in any/all external relationships prior to giving an academic presentation. Daniel Green Disclosure: DO NOT have a financial relationship with any commercial interest.
52. 49 PEDIATRIC OBESITY Orthopaedic Issues Orthopedic Slipped capital femoral epiphysis 60 to 80% are obese Blount’s disease (Tibia vara) (Bow Legs) 70% are obese Knock Knees Degenerative Arthritis Patella Instability/Patella Dislocations Unique Fracture Patterns
53. Slipped Capital Femoral Epiphysis (SCFE): The most common hip disorder of adolescents, in which the proximal femoral epiphysis is displaced posteriorly on the femoral neck.
54. 51 SCFE: Epidemiology Incidence is related to puberty, with boys at risk in ages 10-17, girls at risk in ages 8-15. Rare post-menarchal 60% are over 95th percentile for age-weight. 80% are over the 80th % percentile 5% had parents with SCFE.
56. SCFE: History Most are NOT associated with a significant amount of trauma. Limp Pain in the groin, thigh or knee. The majority of patient with SCFE are be able to walk.
59. Changes in Gait and Range of Motion in SCFE +/-Antalgic gait + Abductor lurch (Coxalgic gait) External Foot Progression angle Hip externally rotates when it is flexed Decreased internal rotation-especially in flexion. Pain with internal rotation of hip
61. 58 Loder, Richards, Shapiro et al. 54 patients Tx for acute SCFE. Reduction occurred in 26 unstable, 2 stable. 14/30 (47%) unstable had satisfactory result. 24/25 (96%) stable have satisfactory result. 14/30 (47%) unstables went on to AVN. 0/30 stables went on to AVN.
62. “the first essential to treatment is early diagnosis”Philip D. Wilson, Sr., M.D. 1924 59
63. PHILIP D. WILSON THE TREATMENT OF SLIPPING OF THE UPPER FEMORAL EPIPHYSIS WITH MINIMAL DISPLACEMENT J Bone Joint Surg Am. 1938;20:379-399. 60
64. 61 J Bone Joint Surg Am. 1938;20:379-399. “ It-is trite to remark that the best time to treat a disease is from time beginning, but thus statement is so true of slipping of the upper femoral epiphysis that it needs to be emphasized. The earliest stages of slipping almost always give rise to symptoms which, if the physician is alert, can he recognized and will lead to time correct diagnosis.”
65. 62 J Bone Joint Surg Am. 1938;20:379-399. “Given a patient between the ages of ten and sixteen years, complaining of intermittent pain and stiffness in the knee or thigh with at times a noticeable limp, one should consider slipping of the epiphysis as one of the first possibilities. Nor should one be led astray by the frequent localization of pain at the inner side of the knee into making only a local examination of that part; a thorough examination of the entire extremity should be made.”
69. Normal Alignment in Children Non-obese children at the age of 3-4 years old develop physiologic genuvalgum that naturally straightens out by the age of 8. 66
74. Obesity and Lower Extremity Malalignment It is largely assumed that obesity places children at higher risk for slipped capital femoral epiphysis (SCFE), genuvalgum, and tibia vara.
75. The Effect of Pediatric Obesity on Lower Limb Alignment Daniel W. Green, M.D. Shevaun Doyle, M.D. Sarah Yagerman 72
76. 73 Compared with non-overweight children, those who are obesehave a greater prevalence of valgus and varus lower extremity malalignment as measured with a goniometer. Hypothesis
77. Physical Exam: Weight & height. TFA, IM distance. ROM angles of the hip, knees, ankles, and spine. Photograph of standing AP alignment of legs. Parent Reported Child Health Questionnaire (CHQ-PF28): Evaluation of children’s physical and psychosocial well-being. Pediatric/Adolescent Outcomes Questionnaire: Assessment of overall physical function Methods
80. Intermalleolar distance the width between the ankles when the patella are forward and the knees are just touch in a patient with genu valgum Average IM distance in obese group (±SD): 8.1 ± 4.4cm Control group IM distance (±SD): 3.4 ± 2.1cm 77
81. Obese children, BMI >95th percentile, have greater genu valgum than non-overweight children. Summary
82. 79 Bow Legs: Tibia Vara (Blount’s Disease) Should be suspected if bowing persists past 2 years Abnormal growth at the medial aspect of the proximal tibial physis Associated with obesity; most common in African-Americans Continues to worsen unless diagnosis and appropriate treatment are accomplished
83. 80 Tibia Vara (Blount’s Disease) Three types: Infantile, juvenile, adolescent Infantile: birth to 3 years, most common form, usually seen in obese children who walked before 1 year, usually noticed when walking began and has persisted, may be bilateral or may resolve on one side and persist on the other Juvenile: onset at 4-10 years of age, obesity risk factor, more often unilateral, usually less severe Adolescent: older than 11 years of age, most common in obese African American males
84. Tibia Vara: Radiographic Evaluation AP radiograph both legs standing Metaphyseal beaking Metaphyseal-diaphyseal angle (Drennan) obtained by measuring the angle formed by a line parallel to the top of the proximal tibial metaphysis and a line perpendicular to the long axis of the tibial shaft 81
97. 94 Implant Mediated Guided Growth Hemiepiphysiodesis: Excellent technique for obese children Utilizes growth to correct deformity Growth plates must be open Earlier detection of mal-alignment in obese children will provide better surgical outcomes Outpatient procedure
115. 112 References The Development of the Tibiofemoral Angle in Children PENTTI SALENIUS, M.D.*, AND ElLA VANKKA, M.D.*, J Bone Joint Surg Am. 1975;57:259-261. Correlation of Body Mass Index and Radiographic Deformities in Children with Blount Disease By Sanjeev Sabharwal, MD, Caixia Zhao, MD, and Emily McClemens, PA-CJ Bone Joint Surg Am. 2007;89:1275-1283